Clover Health locks in 5-Star Medicare bonus payments for 2028
As seen on the 24/7 Wall St. homepage on November 4, 2026.
Through Clover Assistant, we are committed to delivering better clinical quality and lower total cost of care. We are pleased that this continues to show up in our results, with ~98% of our members enrolled in our 5 Star rated PPO for Payment Year 2028, alongside our third consecutive year of nation-leading HEDIS performance.
Star ratings are where Medicare Advantage bonus money is won or lost, and while CVS and Aetna fight CMS in court over their downgrades, Clover's CEO says nearly all of its membership sits in a 5-Star plan for Payment Year 2028. That locks in bonus payments at a $2 billion company whose rivals are litigating to protect theirs.
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Medicare Advantage star ratings determine whether a plan receives bonus payments from the Centers for Medicare and Medicaid Services, and those bonuses can represent a meaningful share of a plan's revenue. A 5-Star rating is the ceiling, and the payment uplift that comes with it is locked in a year ahead of when it takes effect.
Clover Health CEO Andrew Toy disclosed during the company's 2026 Q3 earnings report that approximately 98% of its members are enrolled in a 5-Star rated PPO for Payment Year 2028. That figure matters because it means nearly the entire membership base qualifies for the highest bonus tier, rather than a fraction of it.
The timing is pointed. CVS Health's Aetna and other large Medicare Advantage carriers are currently in litigation against CMS challenging star rating downgrades that threaten their own bonus payments. Clover is on the opposite end of that dynamic, having earned its rating through the performance process rather than contesting a demotion in court.
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Toy also noted that this result represents the company's third consecutive year of nation-leading HEDIS performance, the standardized measure of clinical quality and care delivery used across the industry. Sustained HEDIS leadership is the upstream driver of star ratings, so the consistency of that record matters as much as any single year's outcome.
The company's Clover Assistant platform is cited as the clinical engine behind these results, and management is treating the star rating as validation of that technology's real-world impact on member care quality and cost. For investors, the question going forward is whether the bonus payment certainty translates into durable margin improvement at a company of this scale.
Sources
Mentioned: CLOV